See discussions, stats, and author profiles for this publication at: https://www.researchgate.

net/publication/271822764

An epidemiological analysis of cancer patients admitted to hospitals in

Chennai, Tamil Nadu

Article · February 2015

DOI: 10.5455/2394-6040.ijcmph20150202

CITATION

2 authors, including:

S Gopalakrishnan
Sree Balaji Medical College and Hospital, Bharath University
112 PUBLICATIONS   251 CITATIONS   

SEE PROFILE

Some of the authors of this publication are also working on these related projects:

Review on Health Care Delivery View project

Research Activities of the Department View project

All content following this page was uploaded by S Gopalakrishnan on 04 February 2015.

The user has requested enhancement of the downloaded file.

International Journal of Community Medicine and Public Health
Gopalakrishnan S et al. Int J Community Med Public Health. 2015 Feb;2(1):3-9
http://www.ijcmph.com pISSN 2394-6032 | eISSN 2394-6040

DOI: 10.5455/2394-6040.ijcmph20150202
Review Article

An epidemiological analysis of cancer patients

admitted to hospitals in Chennai, Tamil Nadu
Sekaran Gopalakrishnan*, Ramachandran Umadevi

Department of Community Medicine, Sree Balaji Medical College & Hospital, Bharath University, Chrompet,
Chennai-600044, Tamil Nadu, India

Received: 9 December 2014

Accepted: 10 January 2015

*Correspondence:
Dr. Sekaran Gopalakrishnan,
E-mail: drsgopal@gmail.com

Copyright: © the author(s), publisher and licensee Medip Academy. This is an open-access article distributed under
the terms of the Creative Commons Attribution Non-Commercial License, which permits unrestricted non-commercial
use, distribution, and reproduction in any medium, provided the original work is properly cited.

ABSTRACT

India is now in the epidemiological transition stage of having to face the challenge of increasing number of both
communicable and non-communicable diseases burden. Recently cancers have become the second most fatal disease
among the non-communicable diseases category next only to cardiovascular diseases. Cancer affects all age groups
and both sexes with a high mortality rate and low survival rate. Cancer registration is the process of continuing
systematic collection of epidemiological data on reportable neoplasms with the purpose of helping to assess and
control the impact of malignant disease in the community. The cancer registries are mainly of two types: Population
based cancer registry and hospital based cancer registry. The Population-Based Cancer Registries (PBCRs) are aimed
to identify all cases of cancer that occur in a defined population while Hospital Based Cancer Registries (HBCRs) aim
at the improvement of cancer therapy. Recently, the Madras Metropolitan Tumour Registry (MMTR) Chennai had
published a report on various hospital based statistics about cancer patients from 2007-2010. The report gives
exhaustive details of nearly 13 categories of variables related to cancer management and characteristics attributed to
both males and females patients separately. Objective of this article is to analyze the epidemiological details of cancer
patients registered with the reporting hospitals in Chennai in relation to the age, sex, site of cancers, diagnostic
methods, treatment of choice, mortality etc. among the cancer groups based on the cancer registry for the period from
2007 to 2010, in order to understand the epidemiological trend of the disease in and around Chennai at present.

Keywords: Cancer epidemiology, Cancer registry, Madras metropolitan tumour registry

INTRODUCTION Non-communicable diseases including cancer are

The demographic transition in India is shown in the form
of declining fertility levels and increasing life
expectancy. As the life expectancy at birth increases, the
percentage of geriatric population also rises. Higher
incidence of non-communicable diseases, especially
cancer is positively associated with percentage of aged
population of a country.1 Population ageing is often
assumed to be the main factor driving increases in cancer
incidence, death rates, and health-care costs.2
emerging as major public health problems in India. These
diseases are lifestyle related and have a long latent period
and needs specialized infrastructure and human resource
for prevention and treatment. The main risk factors of the
major non-communicable diseases including cancers are
tobacco usage, unhealthy dietary habits, inadequate
physical activity and alcohol consumption. Based on the
cancer registry data it is estimated that there will be about
8 lakh new cancers cases in India every year and at any
given point of time there is likely to be 3 times this load
that is about 24 lakh cases.3

International Journal of Community Medicine and Public Health | January-March 2015 | Vol 2 | Issue 1 Page 3
 Gopalakrishnan S et al. Int J Community Med Public Health. 2015 Feb;2(1):3-9
Cancer has now attained the status of the second most
common non communicable disease in India responsible
for maximum mortality with about 0.3 million deaths per
year. This can be attributed to the poor availability of
preventive measures, diagnostic methods and treatment
facilities for the disease. All types of cancers have been
reported in Indian population. The causes of high
incidence of these cancers may be both internal (genetic,
mutations, hormonal, poor immune conditions) and
external or environmental factors (food habits,
industrialization, over growth of population, social
conditions etc.).4
Cancer is a group of diseases with lot of similar
characteristics. Cancer can occur in all living cells in the
body and different cancer types have different natural
history. Epidemiological studies have shown that about
80% of all cancers are environmental related. Lifestyle
related risk factors are the most important and
preventable among the environmental exposures.3
In India, lung and oral cancer are the most common types
of cancers among men, whereas cervical and breast
cancer among women. There were 556,400 cancer-related
deaths in India in the year 2010. Out of which, 71% of
cancer patients were of the age group between 30-69
years.5 Since cancer is the second largest non-
communicable disease in India, with a sizeable
contribution in the total number of deaths, it is important
for the public health professionals to understand the
dynamics of cancer epidemiology for planning future
strategies.1 The World Cancer Report documents that
cancer rates are set to increase at an alarming rate
globally. World cancer rates are projected to increase by
50% (to 15 million) new cases by the year 2020.6
Cancer registries
The idea of recording information on all cancer cases in
defined communities dates from the first half of the
twentieth century, and there has been a steady growth in
the number of such cancer registries since. Originally,
they were concerned primarily with describing cancer
patterns and trends. Later, many were able to follow up
the registered patients and calculate survival. In the last
20 years the role of registries has expanded further to
embrace the planning and evaluation of cancer control
activities, and the care of individual cancer patients.7
Cancer registration is the process of continuing
systematic collection of data on the occurrence,
characteristics, and outcome of reportable neoplasms
with the purpose of helping to assess and control the
impact of malignant disease in the community. The
cancer registries are mainly two types: population based
cancer registry and hospital based cancer registry.
The Population-Based Cancer Registries (PBCRs) are
aimed to identify all cases of cancer that occur in a
defined population. PBCRs are an essential component of
International Journal of Community Medicine and Public Health | January-March 2015 | Vol 2 | Issue 1
a fully developed cancer-control programme. In addition
to providing information on current and future needs for
services, they are used to monitor programmes of
prevention, early detection and cure (treatment). 7
Population-based cancer registries monitor the frequency
of new cancer cases (so-called incident cases) every year
in well-defined populations and over time by collecting
case reports from different sources (treatment facilities,
clinicians and pathologists, and death certificates).
Hospital based cancer registries (HBCRs) aim at the
improvement of cancer therapy. Therefore they collect
detailed data about diagnosis, therapy and survival of the
cancer patients. The purpose of the hospital-based
registry is to serve the needs of the hospital
administration, the hospital's cancer programme, and
above all, the individual patient. One of the functions of a
hospital registry is to produce an annual report to the
hospital administration on the cancer activities that have
taken place during the year and to document things such
as the cancer burden borne by the hospital.8
Hospital Based Cancer Registries (HBCRs) provide an
idea of the magnitude and patterns of patient care in a
given hospital. They help in planning the facilities
required in the respective hospital and help in evaluation
of outcome of treatment. They also contribute to the
population based cancer registry in the given area and
help to undertake epidemiologic research.
India is the one of the few developing countries that has
formulated a national cancer control programme which
envisages control of tobacco related cancers; early
diagnosis and treatment of uterine cervical cancer; and
distribution of therapy services, pain relief and palliative
care through augmentation of health infrastructure. 3
To understand the depth of the problem and cancer
burden, The National Cancer Registry Programme
(NCRP) was commenced by the Indian Council of
Medical Research (ICMR) with a network of cancer
registries across the country in December 1981. Three
Population Based Cancer Registries (PBCRs) at
Bangalore, Chennai and Mumbai and three Hospital
Based Cancer Registries (HBCRs) at Chandigarh,
Dibrugarh and Thiruvananthapuram were commenced
from 1 January 1982.
The PBCRs have gradually expanded over the years and
as of now there are 23 PBCRs under the NCRP network.
The Madras Metropolitan Tumour Registry (MMTR), a
Population Based Cancer Registry, was established at the
Cancer Institute, Adayar (W.I.A) in 1981. It caters to an
area of 170 square km and a population (entirely urban)
of 4.6 million as per 2011 Census constituting 0.4% and
6.0% of total population of India and State of Tamil Nadu
respectively. Registration of cases is done by active
method and MMTR continues to get good support from
all health care facilities in and around Chennai, with more
than 240 sources of hospitals, nursing homes, clinics,
Page 4
 Gopalakrishnan S et al. Int J Community Med Public Health. 2015 Feb;2(1):3-9

pathology laboratories, imaging centers, hospices etc.
both in the government and private sector. This helps
MMTR to publish periodic reports and do
epidemiological studies on cancer incidence pattern and
trend.9
Recently, MMTR Chennai has published a report on
various hospital based statistics of the different types of
cancer patients enrolled, diagnosed, treated and their
survival status etc. from 2007-2010. The report gives
exhaustive details of nearly 13 categories of variables
related to the cancer characteristics attributed to both
males and females patients separately. Out of that few
very relevant demographic, morbidity, diagnostic,
therapeutic and mortality aspects have been analyzed here
to understand the cancer trends in Chennai at present.
(around 60% affected). While among females the highest
incidence was found to be in the 30-49 year age group
(around 61%) followed by 50-59 age group (around
54%). Thus it seems the young and the old among the
males have more incidence of cancer while the middle
aged women have more incidence of cancer (Table 1).
The data shows that the highest incidence of cancer was
in the age group of 50 -59 years with 8776 (26.41%)
cases followed by 60-69 years age group with 7446
(22.41%) and 40-49 years age group with 7105 (21.38%)
cases. The least reported incidence was in the less than 10
year age group with 472 (1.42%) cases. The data from
Table 1 shows that as age advances the incidence of
cancer also increases. The incidence is more above the
age of 40 years.

Objective of this article: In this review article, an attempt Table 1: Age group and sex wise distribution of
has been made to epidemiologically analyze the details of prevalence of cancer among patients (2007-2010).
cancer patients registered with the reporting hospitals in
Chennai in relation to the age, sex, site of cancers, Age Male Female Total
diagnostic methods, treatment of choice, mortality etc. group No % No % No %
among the cancer groups based on the cancer registry for 0-9 292 61.86 180 38.14 472 1.42
a period from 2007 to 2010, in order to understand the 10-19 511 60.62 332 39.38 843 2.54
trend of the disease. 20-29 836 52.48 757 47.52 1593 4.79
30-39 1397 39.36 2152 60.64 3549 10.68
METHODOLOGY 40-49 2617 36.83 4488 63.17 7105 21.38
50-59 4020 45.81 4756 54.19 8776 26.41
This record based review was done using the data
60-69 4004 53.77 3442 46.23 7446 22.41
published in the national cancer registry. The data
analyzed was taken from the Chennai registry which is >70 2054 59.61 1392 40.39 3446 10.37
known as the Madras Metropolitan Tumour Registry Total 15731 47.34 17499 52.66 33230 100.00
(MMTR). All Chennai hospitals catering to the cancer
patients in the metropolitan area come under this registry. Cancer site of origin
The hospital based data collected was for a period of four
years from 2007-2010 which was published in national The data was analyzed to find out the top cancer sites
cancer registry website.10 among males and females patients based on the site of
origin diagnosed. Among the male patients, cancer of
The data was analyzed for age and sex wise distribution, Stomach (9.2%) is the leading site followed closely by Ca
followed by the leading types [causes] of cancer based on lungs (8.9%). Cancer mouth, pharynx, leukaemias,
site of affection. The top ten cancers based on site of tongue, oesophagus, colon-rectal and anal canal also were
origin and the various methods of diagnosis of cancers commonly seen. Among the female patients, cancer of
for both the sexes were also compiled. Finally the total cervix-uteri (25.5%) and Ca breast (22.4%) were the top
number of deaths due to cancer was analyzed. The age cancer sites. This is followed by Ca ovary (5.3%), mouth
wise distribution was done in order to find out the age (5.2%), leukaemias (4.0%), stomach (3.7%), oesophagus
group wise distribution of cancer among the population. (3.2%) and colon-rectal-anal canal (3.0%). Registry had
Based on the total number of deaths, the mortality to documented cancers identified from about 50 different
incident rate of cancer for Chennai was also calculated. sites in body and from among them the most commonly
prevalent had been mentioned above (Table 2).
RESULTS OF THE ANALYSIS
Methods of diagnosis
Age and sex distribution
Different methods were used to diagnose cancer when the
The analysis of the cancer registry data shows that the patient approaches the health facility. The most
total number of cancer patients registered in the MMTR commonly used diagnostic techniques for diagnosis of
for the years 2007 to 2010 was 33230. Among them cancers were microscopy (which includes histology,
males were 15731 (47.34%) and females were 17499 cytology, blood films, bone marrow study etc.), X-ray /
(52.66%). Sex wise distribution among males shows that imaging techniques and clinical assessment. Microscopy
the highest incidence of cancer was found in the age was the most common diagnostic method used to
group of 0-19 years and those above 70 years age group diagnose 82.44% of the patients, followed by X-ray /

International Journal of Community Medicine and Public Health | January-March 2015 | Vol 2 | Issue 1 Page 5
 Gopalakrishnan S et al. Int J Community Med Public Health. 2015 Feb;2(1):3-9

imaging techniques (8.39%). Clinically, the diagnosis chemotherapy and surgery + chemotherapy and
was done in 7.78% patients. X-ray / imaging method are radiotherapy alone were female patients (Table 4).
used more among the male patients (62.70%) when
compared to the female patients (37.30%) (Table 3). Table 4: Type of treatment procedures used for all
site cancers only at the regional institute (2007-2010)
Table 2: Top cancers by site of origin among male and (excluding the cancers previously treated).
female patients (2007-2010).
Type of Male Female Total
Common Male Common Female treatment
No % No % No %
cancer sites cancer sites used
among No % among No % Surgery [S] 527 57.72 386 42.28 913 8.62
males females Radiotherapy
492 39.14 765 60.86 1257 11.86
[R]
Stomach 1446 9.2 Cervix Uteri 4462 25.5
Chemotherapy
Lungs 1404 8.9 Breast 3921 22.4 1211 57.15 908 42.85 2119 20.00
[C]
Mouth 1351 8,6 Ovary 921 5.3 S+R 163 43.82 209 56.18 372 3.51
Pharynx 1193 7.6 Mouth 914 5.2 S+C 192 36.57 333 63.43 525 4.95
Leukaemias 1165 7.4 Leukaemias 710 4.0 R+C 1176 38.86 1850 61.14 3026 28.56
Tongue 1061 6.7 Stomach 645 3.7 S+R+C 216 26.18 609 73.82 825 7.79
Oesophagus 892 5.7 Oesophagus 599 3.2 Others 137 8.78 1423 91.22 1560 14.72
Colon-rectal- Colon-rectal- Total 4114 38.82 6483 61.18 10597 100.00
823 5.2 531 3.0
anal canal anal canal
Non- Among those who underwent surgery or radiotherapy
Hodgkin’s 655 4.2 Thyroid 467 2.7 treatment, about 57.72% were male patients while among
lymphomas those received combination therapy of surgery +
Other sites 5741 36.5 Other sites 4329 25.0 radiotherapy, 43.82% were male patients. The data shows
that radical treatment was the most favored treatment
Total 15731 100 Total 17499 100
adopted by institutions to treat patients with different type
of cancers. Nearly 89.93% of the patients underwent
(Cancers have been identified from about 50 different sites in
the body)
radical treatment while only 10.07% were considered for
palliative treatment. Among them about 60% were female
Table 3: Method of diagnosis of cancers for all sites patients (Table 5).
(2007-2010).
Table 5: Method of treatment adopted by institutions
Female to treat cancers (2007-2010) (excluding the cancers
Method of Male patients Total previously treated).
patients
diagnosis
No % No % No %
Microscopy 12422 45.34 14973 54.66 27395 82.44 Method of Male Female Total
X-ray / treatment
1748 62.70 1040 37.30 2788 8.39 No % No % No %
imaging adopted
Clinical 1258 48.65 1328 51.35 2586 7.78 Radical
3679 38.60 5851 61.40 9530 89.93
Others 303 65.73 158 34.27 461 1.39 treatment
Total 15731 47.34 17499 52.66 33230 100.0 Palliative
435 40.76 632 59.23 1067 10.07
treatment
(Microscopy = Histology, cytology, blood films, bone marrow Total 4114 38.82 6483 61.18 10597 100
study and other methods)
Marital status and cancer
Treatment methods used
Cancers of different types were found to be very high
The most common treatment procedure of choice for among married men and women. Among the 15731
most of the patients was combination of radiotherapy and cancer affected male patients, 86.5% were married while
chemotherapy (28.56%). This is followed by only 10.6% were unmarried. Among the 17499 cancer
chemotherapy alone (20.00%) and radiotherapy alone affected female patients, 72.6% were married when
(11.86%). Surgery alone was the treatment of choice for compared to unmarried women (4.9%) while 21.2%
about 8.62% patients while a combination of surgery + affected were widows.
chemotherapy + radiotherapy was given to 7.79% of
patients. Among 825 patients who received combination Mortality due to cancers
therapy of surgery + chemotherapy + radiotherapy, about
73.82% were female patients and about an average 60% The data released for the three years from 2006 to 2008
of those who received combination of radiotherapy + shows the mortality pattern among the cancer affected

International Journal of Community Medicine and Public Health | January-March 2015 | Vol 2 | Issue 1 Page 6
 Gopalakrishnan S et al. Int J Community Med Public Health. 2015 Feb;2(1):3-9

patients in relation to age group and sex. The mortality frequent types of cancer differ between men and
rate increases as the age advances. Cancer patients above women.11
60 years of age showed the highest mortality rate of
46.28% followed by 40.91% belonging to the age group Population ageing is often assumed to be the main factor
of 40-59 years. Thus about 87% of mortality among driving increases in cancer incidence, death rates, and
cancer affected patients is seen in the age group above 40 health-care costs.2 Cancer is a major cause of morbidity
years while among children and adolescents the mortality and mortality in developing and developed countries
rate was only 3.32%. Overall mortality rate among males alike. In many low-income and middle-income countries,
is higher (54.52%) when compared to females (45.48%) including India, most of the population does not have
(Table 6). access to a well-organized and well regulated cancer care
system.12 The National Cancer Registry Programme
Table 6: Age group and sex wise mortality due to (NCRP, established by the Indian Council of Medical
cancers in Chennai (2006-2008)*. Research in 1981) provides population-based data from a
selected network of 28 cancer registries located across the
Age Male Female Total country.13
group No % No % No %
0-19 73 58.87 51 41.13 124 3.32 This review shows that the young and the old among the
20-39 171 48.17 184 51.83 355 9.49 males have more incidence of cancer while the middle
40-59 790 51.63 740 48.37 1530 40.91 aged women have more incidence of cancer. The data
>60 1005 58.06 726 41.94 1731 46.28 from the registry shows that as age advances the
incidence of cancer also increases. The incidence is more
Total 2039 54.52 1701 45.48 3740 100.00
above the age of 40 years contributing to nearly 70% of
the cancer patients reported. The least reported incidence
*Mortality data available only from 2006 to 2008 period
was found among the less than 10 year age group.
Among the male patients, cancer of Stomach is the
Case fatality rate due to cancers
leading site followed closely by Ca lungs while among
the female patients, cancer of cervix-uteri and Ca breast
The overall case fatality due to cancers for the years
were the predominant cancer sites.
2006-2008 shows that out of 15258 cancer patients
registered, 3740 (24.51%) patients died. Among the
A study conducted by Mohandas KM et al. based on all
males cancer patients, 27.58% died while among female
India statistics shows that Indian men were mostly
cancer patients, 21.62 % died. This data also shows that
suffering from oral, lung, stomach, colorectal,
mortality among male patients was more when compared
pharyngeal, and esophageal cancers while among the
to female patients (Table 7).
females, incidence of breast, cervical, and colorectal
cancers are more marked. In women, breast cancer is the
Table 7: Case fatality rate due to cancers in Chennai most common cause of cancer deaths, and the most
(2006-2008)*. frequently diagnosed cancer, accounting for more than 1
in 5 of all deaths from cancer in women. In men, the
Case fatality
Gender Incidence Mortality more common cancers are tobacco-related. For Indian
rate (%)
women, cervical cancer is the second most common
Male 7392 2039 27.58 % incident cancer.12 About 40% of all cancers in India are
Female 7866 1701 21.62 % attributable to tobacco.
Total 15258 3740 24.51%
The most commonly used diagnostic techniques for
*Mortality data available only from 2006 to 2008 period diagnosis of cancers were predominantly based on
microscopy which includes histology, cytology, blood
DISCUSSION films, bone marrow study etc. The combination of
radiotherapy and chemotherapy was the most common
Cancer is a group of diseases involving abnormal cell treatment procedure of choice for most of the patients
growth with the potential to invade or spread to other which was followed by chemotherapy alone and
parts of the body. There are over 100 different known radiotherapy alone. Surgery was also used as the
cancers that affect humans. Most cancers are named for treatment of choice for sizeable patients. Nearly 90% of
the organ or type of cell in which they start - for example, the patients underwent radical treatment while only 10%
cancer that begins in the colon is called colon cancer; were considered for palliative treatment. Among the male
cancer that begins in melanocytes of the skin is called patients, 86.5% were married while among the female
melanoma. Cancers figure among the leading causes of patients, 72.6% were married.
death worldwide, accounting for 8.2 million deaths in
2012. Lung, liver, stomach, colorectal and breast cancers The review also shows that the mortality rate increases as
cause the most cancer deaths each year. The most the age advances. Cancer patients above 60 years of age
showed the highest mortality rate. Mortality among

International Journal of Community Medicine and Public Health | January-March 2015 | Vol 2 | Issue 1 Page 7
 Gopalakrishnan S et al. Int J Community Med Public Health. 2015 Feb;2(1):3-9
cancer patients was very high in the age group above 40
years while among children and adolescents the mortality
rate was very less. Overall mortality rate among males
was higher when compared to females.
The overall case fatality rate due to cancer was about
25% as per the data available. Mohandas KM et.al
describes that the overall cancer mortality rate in India is
relatively high, at 68% of the annual incidence. This
indicates that fewer than 30% of Indian patients with
cancer survive 5 years or longer after diagnosis. Since
there are limitations in the available data, the true
proportion could be significantly lower.12
In India, quantifying the burden also faces other barriers:
people may not recognize the signs of cancer, or not have
the resources to go to a medical facility. Once at a clinic
or hospital, lack of resources or medical equipment may
mean the diagnosis is not made at the right time. Even
when cancer is recognized, the family may lack the funds
to pursue treatment and decide to abandon therapy before
the patient is registered.
According to an earlier research in India, the three
leading causes of cancer death in men aged 30-69 years
were lung cancer (including larynx and trachea), oral
cancer (including pharynx and lip) and stomach cancer.
For women aged 30-69 years, the three most common
fatal cancers were breast cancer, cervical cancer and
stomach cancer. They also concluded that “Prevention of
tobacco-related and cervical cancers and earlier detection
of treatable cancers would reduce cancer deaths in India”,
particularly in the rural areas that are underserved by
cancer services.
The substantial variation in cancer rates in India suggests
other risk factors or causative agents that remain to be
discovered. The fact that 71% of cancer deaths occur in
those aged 30-69 years emphasizes the substantial social
and economic gains that would be associated with a
successful cancer prevention program. Interventions such
as tobacco control, vaccination against human papilloma
virus and hepatitis B, cervical cancer screening, and early
detection and treatment of oral and breast cancers would
have a substantial effect on the prevention of cancer
deaths.14
To sum up, cancer has become a major killer disease in
the country now. Deaths due to cancers are high among
males and females and also among all age group affected
with it. The overall case fatality rate due to cancer in
Chennai was found to be about 25% which is very high.
Mostly the affected patients report to the hospitals in an
advanced stage of the disease. Hence it will be too late to
receive a possible treatment/cure in spite of the best
effort. Regular cancer screening and early detection of
cancer is still a long way to go. There are only limited
numbers of specialized hospitals, specialists and trained
man power available to tackle this problem in India at
present.
International Journal of Community Medicine and Public Health | January-March 2015 | Vol 2 | Issue 1
CANCER IS PREVENTABLE
About 30% of cancer deaths are due to the five leading
behavioral and dietary risks: high body mass index, low
fruit and vegetable intake, lack of physical activity,
excessive use of tobacco and alcohol.11 From
epidemiological studies, it is clear that 70-90% reasons of
developing cancer are related to environment and to the
lifestyle of a person. So, to a great extent, it is
preventable.3
Heredity also plays its role in causing cancer, which
accounts for just five percent of cancer cases while the
rest is caused by non-heredity factors such as lifestyle,
food we eat, level of physical activity, personal hygiene,
etc.
As per expert’s opinion, all the major forms of cancers
are preventable. Cervical cancer can be fully prevented
with creating awareness among young women. Oral
cancer can be prevented by not using tobacco and
drinking alcohol. By avoiding very spicy and hot food it
is possible to prevent the risk of developing esophageal
and stomach cancer. Regular exercise, for at least 30
minutes in a day is necessary for leading a healthy
lifestyle, which will also contribute to prevention of
diseases like cancers.5
Thus now more emphasis should be given to popularize
the methods and lifestyle modifications which will help
to prevent cancer in the long run.
National cancer control program
The national cancer control program was launched in
1975-76 with the main objectives of prevention, early
diagnosis and treatment of cancers. In view of the
magnitude of the problem and gaps in the availability of
cancer treatment facilities in the country, the program
was revised in 1984-85 and during 2004.15 The main
objectives of the program are:
 Primary prevention of cancers by imparting health
education
 Secondary prevention i.e. early diagnosis of common
cancers such as cancer cervix, mouth, breast and
tobacco related cancers by screening/self-
examination methods
 Tertiary prevention i.e. strengthening of the existing
tertiary care institutions of comprehensive therapy
including palliative care in terminal stage of cancer.
 Training of adequate man power to meet the cancer
control activities.
The National Cancer Control Program has now been
integrated with Diabetes, Cardiovascular diseases and
Stroke from the year 2011.
Page 8
 Gopalakrishnan S et al. Int J Community Med Public Health. 2015 Feb;2(1):3-9
SUMMARY
Most of the cancers are amenable to primary and
primordial prevention and can be prevented and
controlled to a large extent. Health education and
awareness creation about the warning signs for cancer
must be highlighted and periodic screening must he
popularized among the communities. The public sector
alone may not be able to meet all the challenges posed by
cancer in India. It is necessary to have a proper public
private partnership to invest heavily on latest technology
for cancer screening and therapy which will help to
overcome the burden of cancer in the long run.
There is strong need to make cancer a notifiable disease
which may help to improve the assessments of the
regional and national cancer burden. There needs to
establish more number of new and improved cancer
registries covering the uncovered regions so far. Public
health initiatives directed at providing better living
conditions in cities and villages, proper drainage and
protected water supply, appropriate immunizations,
preventing pollutions at all levels, advocating healthy life
style by improving nutrition status of the vulnerable
groups, provide exercise space for prevention of obesity
and better working environment etc. will help to slow the
increase in lifestyle-associated cancers.
More cancer research initiatives are needed to understand
the epidemiological trends happening in our country
which will help to plan and focus on programs to tackle
this menace. Our health care delivery systems at the
primary, secondary and tertiary care levels should be
strengthened to meet the challenges posed by the
spectrum of cancer diseases. All these actions are time
consuming and need strong political will but will have a
long term beneficial effect not only for reducing cancer
but also for the entire diseases burden in our country.
Funding: No funding sources
Conflict of interest: None declared
Ethical approval: Not required
REFERENCES
1. Marimuthu P. Projection of cancer incidence in five
cities and cancer mortality in India. Indian J Cancer.
2008;45(1):4-7.
2. Yancik R. Population aging and cancer: a cross-
national concern. Cancer J. 2005;11(6):437-41.
3. Varghese C. 50 years of cancer control in India. In:
Varghese C, eds. Cancer Prevention and Control in
International Journal of Community Medicine and Public Health | January-March 2015 | Vol 2 | Issue 1
View publication stats
India. New Delhi: MoHFW, Government of India;
2002: 48-59.
4. Imran A, Waseem AW, Kishwar S. Cancer scenario
in India with future perspectives. Cancer Ther.
2011;8:56-70.
5. Kaur R. Rising cases of cancer in India. My India,
2013. Available at:
http://www.mapsofindia.com/my-india/india/rising-
cases-of-cancer-in-india. Accessed 20 September
2014.
6. World Health Organization. World cancer report.
Media centre News releases, 2003. Available at:
http://www.who.int/mediacentre/news/releases/2003
/pr27/en/. Accessed 20 August 2014.
7. Parkin DM. The evolution of the population-based
cancer registry. Nat Rev Cancer. 2006;6:603-12.
8. Young JL. The hospital-based cancer registry. In:
Young JL, eds. Cancer Registration: Principles and
Methods. Lyon (France): IARC; 1991: 177-184.
9. Shanta V, Swaminathan R. Population based cancer
registry, Chennai. In: Shanta V, Swaminathan R,
eds. Individual Registry Data. Adyar, Chennai:
Cancer Institute (WIA); 2009.
10. Shanta V, Swaminathan R, Rama R. Hospital based
cancer registry, Chennai. In: Shanta V,
Swaminathan R, eds. Individual Registry Data.
Adyar, Chennai: Cancer Institute (WIA); 2007-
2010.
11. WHO. Cancer fact sheet N°297, 2014. Available at:
http://www.who.int/mediacentre/factsheets/fs297/en
/. Accessed 21 September 2014.
12. Mallath MK, Taylor DG, Badwe RA, Rath GK,
Shanta V, Pramesh CS, et al. The growing burden of
cancer in India: epidemiology and social context.
Lancet Oncol. 2014;15(6):e205-12.
13. Ncrpindia.org. National cancer registry programme,
2014. Available at: http://www.ncrpindia.org/.
Accessed 19 September 2014.
14. Dikshit R, Gupta P, Ramasundarahettige C,
Gajalakshmi V, Aleksandrowicz L, Badwe R, et al.
Cancer mortality in India: a nationally
representative survey. Lancet.
2012;379(9828):1807-16.
15. Park K. Health programmes in India. In: Park K,
eds. Text Book of Preventive and Social Medicine.
21st ed. Jabalpur, India: M/s Banarsidas Bhanot;
2011: 415.
DOI: 10.5455/2394-6040.ijcmph20150202
Cite this article as: Gopalakrishnan S, Umadevi R.
An epidemiological analysis of cancer patients
admitted to hospitals in Chennai, Tamil Nadu. Int J
Community Med Public Health 2015;2:3-9.
Page 9